P972: RISK-BENEFIT RATIO OF PERCUTANEOUS KYPHOPLASTY AND PERCUTANEOUS VERTEBROPLASTY IN PATIENTS WITH NEWLY DIAGNOSED MULTIPLE MYELOMA WITH VERTEBRAL FRACTURE: A SINGLE-CENTER RETROSPECTIVE STUDY
Authors: Qiuqing Xiang, Minqiu Lu, Lei Shi, Shan Gao, Yutong Wang, Lijuan Fang, Yuehua Ding, Xin Zhao, Yuan Chen, Mengzhen Wang, Weikai Hu, Lifang Wang, Sun Kai, LI Bao
Journal: HemaSphere (2023)

Topic: 14. Myeloma and other monoclonal gammopathies - Clinical Background: The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. A consensus statement from the International Myeloma Working Group (IMWG) has recommended the use of PKP/PVP in the setting of myeloma bone disease. Myeloma is a frequently misdiagnosed hematologic malignancy, but the risk-benefit ratio of performing PKP/PVP prior to diagnosis in myeloma patients remains relatively unknown. Aims: To assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving anti-myeloma therapy. Methods: The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the non-surgical group in the NDMM patients. Results: Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%)(Table 1). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and non-surgical groups was 66 and 62 years, respectively (p=0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II+III 96.9% vs 71.8%, p=0.03; RISS stage III 96.9% vs 71% p=0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months); Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the non-operative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the non-surgical group (75% vs. 2.9%, P=0.001). The time interval between first visit and definitive diagnosis of MM was longer in the surgical group than in the non-surgical group (6.1 months vs. 1.6 months, p=0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the non-surgical group. (48.2 months vs. 66 months, p=0.04) Summary/Conclusion: Application of PKP/PVP surgery for pain relief in NDMM patients without anti-myeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with anti-myeloma therapy prior to any consideration for PKP/PVP surgery.Keywords: Bone disease, Multiple myeloma, Surgery